Cytomegalovirus as a cause of very late interstitial pneumonia after bone marrow transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 26; no. 4; pp. 443 - 444
• Main Authors: DE MEDEIROS, C. R, MOREIRA, V. A, PASQUINI, R
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.08.2000
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigenemia; Antigens, Viral - blood; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone Marrow Transplantation - adverse effects; Bone marrow, stem cells transplantation. Graft versus host reaction; Cytomegalovirus; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - prevention & control; Ganciclovir; Ganciclovir - administration & dosage; Human cytomegalovirus; Humans; Immunosuppression - adverse effects; Infections; Lung Diseases, Interstitial - drug therapy; Lung Diseases, Interstitial - prevention & control; Lung Diseases, Interstitial - virology; Lymphocytes; Lymphocytes T; Male; Medical sciences; Morbidity; Mortality; Patients; Pneumonia; Pneumonia, Viral - drug therapy; Pneumonia, Viral - etiology; Pneumonia, Viral - prevention & control; Premedication; Prophylaxis; Risk groups; Stem cell transplantation; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Viremia - drug therapy; Viremia - etiology; Viremia - prevention & control; Human; Lung disease; Late; Respiratory disease; Herpesviridae; Homograft; Male; Malignant hemopathy; Betaherpesvirinae; Myelodysplastic syndrome; Human cytomegalovirus; Infection; Virus; Case study; Treatment; Viral disease; Bone marrow; Interstitial pneumonitis; Adult; Complication; Graft
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1702538

Cytomegalovirus (CMV) infection is an important cause of morbidity and mortality after allogeneic transplant. Interstitial pneumonia (IP) is the most common manifestation of CMV in BMT patients, with a 30-48% mortality rate despite adequate treatment. Most CMV infection occurs in the first 100 days. However, prolonged ganciclovir (GCV) prophylaxis has favored the occurrence of late CMV IP, probably by inhibition of the development of CMV-specific T cell lymphocyte responses. We report the case of a patient treated with an allogeneic BMT who received pre-emptive GCV until day +100 because of CMV-positive antigenemia. He developed a CMV IP on day +811 post BMT, which responded to treatment. We intend to alert clinicians that even at long-term (>1 year) post-BMT, CMV is a possible cause of IP in high-risk patients.